title: The relationship between visceral adiposity and left ventricular diastolic function: results from the Baltimore Longitudinal Study of Aging.
abstract: OBJECTIVE
  It is unclear whether subcutaneous and visceral fat are differentially correlated to the decline in left ventricular (LV) diastolic function with aging. This study sought to examine the hypothesis that age-related changes in the regional fat distribution account for changes in LV diastolic function and to explore potential mediators of this association.
  
  
  RESULTS
  In this cross-sectional study, we evaluated 843 participants of the Baltimore Longitudinal Study of Aging with echocardiogram, dual-energy X-ray absorptiometry (DEXA), abdominal computed tomography (CT) and blood tests performed at the same visit. LV diastolic function was assessed by parameters of LV relaxation (E/A ratio, Em and Em/Am ratio) and LV filling pressures (E/Em ratio). Total body fat was computed by DEXA, while visceral and subcutaneous fat were determined from abdominal CT. In multivariate models adjusted for demographics, cardiovascular risk factors, antihypertensive medications, physical activity and LV mass, both visceral and subcutaneous fat were associated with LV diastolic dysfunction. When both measures of adiposity were simultaneously included in the same model, only visceral fat was significantly associated with LV diastolic dysfunction. Triglycerides and sex-hormone binding globulin, but not adiponectin and leptin, were found to be significant mediators of the relationship between visceral fat and LV diastolic function, explaining 28-47% of the association. Bootstrapping analyses confirmed the significance of these findings.
  
  
  CONCLUSIONS
  Increased visceral adiposity is associated with LV diastolic dysfunction, possibly through a metabolic pathway involving blood lipids and ectopic fat accumulation rather than adipokines.
authors.affiliation: Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, MD, USA; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, NIA/NIH, Baltimore, MD, USA; Research Center of Cardiovascular Biology, University of Genova, Genova, Italy. Electronic address: marco.canepa@nih.gov.
authors.forename: M
authors.initials: M
authors.lastname: Canepa
authors.forename: J B
authors.initials: JB
authors.lastname: Strait
authors.forename: Y
authors.initials: Y
authors.lastname: Milaneschi
authors.forename: M
authors.initials: M
authors.lastname: AlGhatrif
authors.forename: R
authors.initials: R
authors.lastname: Ramachandran
authors.forename: S
authors.initials: S
authors.lastname: Makrogiannis
authors.forename: M
authors.initials: M
authors.lastname: Moni
authors.forename: M
authors.initials: M
authors.lastname: David
authors.forename: C
authors.initials: C
authors.lastname: Brunelli
authors.forename: E G
authors.initials: EG
authors.lastname: Lakatta
authors.forename: L
authors.initials: L
authors.lastname: Ferrucci
mesh_terms: D015502:Absorptiometry, Photon; D052242:Adiponectin / Q000097:blood; D050154:Adiposity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015142:Baltimore; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000502:physiology*; D020738:Leptin / Q000097:blood; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D050151:Subcutaneous Fat / Q000502:physiology; D014280:Triglycerides / Q000097:blood; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D052242:Adiponectin; D020738:Leptin; D014280:Triglycerides
keywords: Adipokines; Adiposity; Diastolic function; Sex hormone-binding globulin; Triglycerides